OUYANG Suhui
The aim of this study was to explore the distribution of infection pathogens and drug resistance of main pathogens in neonates in neonatal intensive care unit (NICU), and to analyze the risk factors of nosocomial infection. A retrospective analysis was performed on the clinical data of 2 812 neonates in NICU of Nanjing Maternal and Child Health Hospital from January 2022 to December 2023. According to the presence or absence of nosocomial infection, neonates were divided into infection group (453 cases) and non-infection group (2 359 cases). The distribution of pathogens and drug resistance of main pathogens in infection group were analyzed. The risk factors of nosocomial infection were analyzed by Logistic regression analysis. Among 2 812 neonates in NICU, there were 453 cases (16.11%) with nosocomial infection. A total of 475 strains of pathogens were detected, mainly Gram-positive bacteria (58.32%). Among Gram-positive bacteria, coagulase-negative staphylococci had high resistance rates to penicillin C (93.57%), erythromycin (76.61%) and oxacillin (71.93%), but were sensitive to rifampin (8.19%), nitrofurantoin (1.75%), vancomycin and linezolid. Staphylococcus aureus was completely resistant to penicillin C (100%), but had no resistance to rifampicin and vancomycin. Among the gram-negative bacteria, Escherichia coli was significantly resistant to ceftriaxone (47.95%) and cefazolin (41.10%), while Klebsiella pneumoniae was highly resistant to ceftazidime (44.64%) and ceftriaxone (39.29%), but both of them were completely sensitive to imipenem and amikacin. Compared with the non-infection group, the infection group had a significantly higher proportion of infants with gestational age <37 weeks, birth weight <2 500 g, cesarean section, Apgar score ≤7 at 5 min after birth, asphyxia rescue, mechanical ventilation, parenteral nutrition, types of antibiotics ≥2, duration of antibiotic use >7 days, and length of ICU stay >7 days (P<0.05). The main pathogens of nosocomial infection are Gram-positive bacteria in NICU neonates, with high resistance rates to penicillin and erythromycin, but still sensitive to vancomycin and linezolid. Gestational age <37 weeks, low birth weight, mechanical ventilation, combined use of antibiotics and stay time in ICU >7 d are independent risk factors of nosocomial infection. It is necessary to standardize invasive operation and antibiotics management, and optimize prevention and control strategies for high-risk neonates.